Recent Posts - Lessons in Speech with Nanette

Why is Mean Length of Utterance (MLU) Important?

Unlocking the Power of Language: Understanding Mean Length of Utterance (MLU)

Language is a powerful tool that allows us to communicate our thoughts, express our emotions, and connect with others on a deeper level. But have you ever wondered how language develops in young children? How do they progress from babbling to forming coherent sentences? One way to measure a child’s language development is by measuring their Mean Length of Utterance (MLU). In this article, we will explore the concept of MLU and its importance in understanding language development.

MLU, or Mean Length of Utterance, measures how many words or parts of words your child typically uses when speaking. It helps track their language development, including vocabulary and grammar growth. By analyzing a child’s MLU, speech pathologists can assess language milestones, identify potential language delays or disorders, and design appropriate interventions.

Understanding MLU is not only crucial for professionals working with children but also for parents who want to support their child’s language development. By unlocking the power of language through MLU, we can foster better communication, enhance social relationships, and open doors to a brighter future for young learners.

Join us as we dive into the fascinating world of MLU and discover how it can unlock the potential of language development in children.

anonymous ethnic tutor helping little multiracial students with task in classroom

How to calculate MLU

Calculating MLU involves analyzing a child’s spoken or written language samples and determining the average number of words or parts of words per utterance. To calculate MLU, follow these steps:

1. Speech pathologists collect a representative language sample from the child. This is typically done during play with the therapist limiting questions and opting for probes to unleash more language. For example, we may say, “Tell me about your favorite toys/ games/ vacation” rather than ask a question that would yield a single word answer.

2. We typically record the language sample to write out sentences later.

3. Next, we count the total number of words or morphemes in the sample. A morpheme is the smallest meaningful unit of language, such as a word or a prefix/suffix. When we calculate MLU, we count morphemes, which are the smallest units of meaning in a word. In “running,” “run” is one morpheme and “-ing” is another, making it two morphemes.

4. Finally, we divide the total number of words or morphemes by the number of utterances (words/phrases/sentences) to obtain the mean length of utterance.

For example, if a child’s language sample consists of 20 utterances with a total of 100 words, the MLU would be 5 (100 words divided by 20 utterances).

Milestones in child language development

MLU milestones indicate the progression of language development in children. As children acquire new language skills and vocabulary, their MLU increases. Here are some general MLU milestones based on age:

12-26 months: At this stage, children typically have an MLU of 1-2 words. They focus on single-word utterances, such as “ball” or “dog.”

27-30 months: MLU expands to 2-3 words as children begin to combine words to form simple phrases or sentences. For example, “want juice” or “big car.”

31-34 months: MLU increases to 3-4 words, and children start using more complex sentence structures. They may use questions like “Where is my toy?” or make statements like “I like ice cream.”

35-40 months: MLU reaches 4-5 words, and children develop more advanced sentence structures. They use conjunctions like “and” or “but” to connect ideas, and their sentences become more grammatically complex.

41-46+ months: MLU continues to grow, and children become more proficient in using complex grammatical structures and expanding their vocabulary.

It is important to note that these milestones are general guidelines, and individual children may progress at different rates. MLU milestones provide a framework for assessing language development but should not be used as the sole indicator of a child’s language skills.

Influential Factors

Several factors can influence a child’s MLU and language development. These factors include:

1. Language exposure and input: The amount and quality of language a child is exposed to can impact their MLU. Children who have rich language environments and frequent interactions with caregivers tend to have higher MLU.

2. Cognitive abilities: Cognitive abilities, such as memory and attention, play a role in language development. Children with stronger cognitive skills may have higher MLU as they can process and produce more complex language.

3. Socioeconomic status (SES): Socioeconomic factors can influence a child’s language development. Children from lower SES backgrounds may experience fewer language-rich environments and have lower MLU compared to their peers.

4. Language disorders or delays: Children with language disorders or delays may have lower MLU compared to typically developing children. MLU can be used as a diagnostic tool to identify potential language difficulties and guide intervention strategies.

5. Bilingualism: Bilingual children may have different MLU patterns depending on their language exposure and proficiency in each language. MLU calculations need to consider both languages when assessing language development in bilingual children.

Understanding these factors can help professionals and caregivers identify potential challenges or areas that require additional support in a child’s language development.

Using MLU as a diagnostic tool for language disorders

MLU is a valuable diagnostic tool for identifying language disorders or delays in children. A lower MLU than expected for a child’s age may indicate potential language difficulties that warrant further assessment and intervention. MLU analysis can help professionals determine if a child is experiencing difficulties with vocabulary acquisition, grammar, or syntactic structures.

MLU, when combined with other language assessments and observations, provides a comprehensive picture of a child’s language skills. It assists in identifying specific areas of language that may require intervention, such as phonological disorders, expressive or receptive language disorders, or pragmatic language difficulties.

Early detection of language disorders is crucial for effective intervention and support. MLU serves as an objective measure that helps professionals make informed decisions and develop targeted intervention strategies to address a child’s specific language needs.

Strategies to promote MLU growth in children

Promoting MLU growth in children involves creating language-rich environments and providing opportunities for meaningful interactions. Here are some strategies to support MLU development:

Engage in interactive conversations: Have frequent conversations with children, encouraging them to respond and express their thoughts. Ask open-ended questions, provide descriptive feedback, and expand on their utterances to model more advanced language structures.

Read aloud and encourage storytelling: Reading books aloud and encouraging children to tell stories helps develop vocabulary, sentence structure, and narrative skills. Engage in discussions about the stories, ask questions, and encourage children to express their opinions and ideas.

Play language-rich games: Engage children in language-rich games, such as “I Spy” or “Simon Says,” that encourage vocabulary development, turn-taking, and following instructions. Incorporate new words and concepts into the games to expand their language skills.

Use visual aids: Visual aids, such as picture cards or drawings, can support language development by providing visual cues and prompting discussions. Use visuals to help children make connections between words, objects, and concepts.

Provide opportunities for peer interactions: Encourage children to interact with peers, as peer interactions promote language development and MLU growth. Arrange playdates or group activities where children can engage in conversations, share ideas, and practice using language in social contexts.

By implementing these strategies, caregivers and educators can create language-rich environments that foster MLU growth and support overall language development in children.

Conclusion: Emphasizing the value of MLU in language assessment and intervention

Mean Length of Utterance (MLU) is a powerful measure that unlocks the potential of language development in children. By analyzing MLU, speech pathologists and caregivers can gain valuable insights into a child’s language skills, identify potential language delays or disorders, and design targeted interventions. MLU serves as a diagnostic tool, guiding language therapy and promoting MLU growth through language-rich environments, interactive conversations, and engaging activities.

Understanding MLU empowers us to support children in their language development journey, fostering effective communication, enhancing social relationships, and opening doors to a brighter future. By unlocking the power of language through MLU, we enable young learners to express themselves, connect with others, and thrive in all aspects of life.

Four Qualities to Look for in Toys to Promote Speech

by Nanette Cote

Baby holding a play phone next to its ear

Embark on a journey to uncover the essential features that make toys the ideal tools for promoting speech development.

One of my primary missions in my speech and language practice is to educate families on the importance of opening the doors to communication. Speech is so much more than talking. It is listening, comprehending, taking turns, gesturing, commenting, asking and answering questions, and requesting to name just a few. The right toy can set the stage for many of these opportunities.

Throughout the year, parents often ask me for advice on toy/ gift ideas, especially near their child’s birthday and holiday season. Some toys are better than others, as they contain certain features important for supporting speech and language development. The toys that catch my eye typically have four things in common:

They make HARDLY ANY noise

portrait photo of woman with brown curly hair doing the shhh sign

I am probably not the first SLP to make this comment and I surely will not be the last! Bottom line is that we want the kids to do the talking. Sometimes that talking is a sound or part of a word and sometimes it is a word/phrase/sentence. It’s nice to be able to hear these moments without interruptions. Some of my favorite, quiet, interactive toys are: Critter Clinic Toy Vet Set, Fisher Price Farm House, Stacking Blocks, Ring Stacking Toy that Spins, Barnyard Bingo, Melissa and Doug’s Wooden School Bus, Matchbox Cars, and dolls.

While we are on the topic of noise, do not fall into the trap in thinking that an electronic book option is any better than a noise-making toy. In my opinion, you should always opt for a quiet interactive book like a lift-the-flap or sensory-enriched option with touch and feel textures if you want your child to progress in his speech and language skills.

Now, having said that, a good, old fashioned single, noise making toy never hurt anyone. For example, the Elefun makes a whirling sound when activated and I’m okay with that because it motivates kids to request “more”, “go”, and “stop.” I also love a good ball popper for bringing out some laughter and excitement, which in turns fosters speech and language usage.

The bottom line is: I steer clear of those toys that kids get trigger happy with and all you hear are a million sounds and words all at once. Not fun. Personally, I avoided noisy, talkative toys when my son was little and I have lived quite happily in my SLP world for a couple decades without all the noise.

They fit right in with my theme

Herein lies my year-round shopping problem. I’m always looking to add materials to my theme units. I cannot help myself. I have to admit that I love bringing out the Fisher Price Thanksgiving sets and Holiday train, Learning Resources camp fire sets, and Super Duper magnetic fish.

One toy that can be used for birthday, Valentine’s Day, and Christmas themes is Mini presents by Learning Resources. First, the client opens a mini box; takes out the object; and then I label it several times while placing it down on a picture of number one. This continues until we get to three total choices. Finally, I ask clients to “get/give me” a targeted object. This super cute set has been fun for my 4-6 year old clients. You can even target pronouns by using a baby doll and practicing, “She wants a purple gift.”

When seasonal toys are only available for a short amount of time, I think you get more bang for your buck from them. It’s the same concept of rotating toys in your home so the old ones feel like new when you cycle through them. For more details on some of my favorite, summer toys, visit my post on seven of my favorites!

They stand the test of time

This rationale is two part: durability and traditional. I like a toy that can take a beating and clean easily, so I reach for the plastic Velcro foods and walk right by felt food. If I cannot clean them fast with a Clorox wipe, then I cannot have them in my therapy closet. While there are always cute, new toys being released, I stick with traditional themes like Mr. Potato heads to work on learning about body parts. Another great option is any toy that is alphabet-related. Two of my favorite hits for kids aged 2-8 years old are ABC puzzles and alphabet toys. What better way to work on letter-sound recognition than with toys?!

You can perform a few different functions with them

baby in a chef hat playing with a toy kitchen in a chef hat

Your child’s speech and language development builds alongside play. The more opportunities you can create to further communication with your child, the better. For example, I prefer a small collection Velcro foods over a 100 piece set of foods that are static.

Having something to do with the object helps you model and teach a functional sequence. In this case, you can gather all the Velcro foods and sort them to make a salad. Then, you “cut” each item and put them in a strainer for rinsing. Finally, you “dry” the slices and transfer them to a bowl. Modeling these real-life events supports teaching your child to make connections with a sequence he has seen before, which in turns strengthens memory skills.

In conclusion, when it comes to selecting toys for speech development, prioritizing those that make hardly any noise, fit the session’s theme, endure over time, and offer versatility is key. These criteria ensure engagement, continuity, and diverse learning opportunities, laying the foundation for effective speech therapy sessions. By choosing toys thoughtfully, you empower your child to thrive in their language journey while making learning enjoyable and effective.

Why Did My Child Qualify For Articulation Therapy?

by Nanette Cote

Woman holding the letter S with child imitating a touch cue in speech therapy

ARTICULATION

Why is understanding the journey of speech sound development crucial, and what is the basis for evaluation and treatment in articulation therapy? Making progress in speech development starts with understanding the evaluation and treatment process for articulation delays, as discussed in this post.

In this comprehensive guide, we will navigate the journey of speech sound development and discuss the basis for evaluation and treatment in articulation therapy. Understanding the milestones and stages of speech sound acquisition is crucial for identifying potential delays and designing effective intervention plans. Articulation therapy, distinct from phonological and childhood apraxia of speech therapies, targets specific speech sound errors to enhance clarity and pronunciation. We’ll explore the various assessment methods used to evaluate speech sound production and discuss evidence-based treatment approaches.

Additionally, we’ll highlight the pivotal role of home programming in reinforcing therapeutic gains and supporting speech progress beyond the therapy room. Join us as we navigate through the fundamentals of speech therapy and empower caregivers with practical strategies for facilitating speech development in children.

Milestones and the Evaluation Process:

Speech pathologists assess speech sound development using a test battery containing all consonant sound targets. Most of the time, a child with an articulation delay can produce vowels accurately, but not consonant sounds. If your child hasn’t mastered age-expected sounds, their score may indicate therapy is necessary. The chart pictured below is my all-time favorite speech development reference tool from 1972 for parents. I particularly like how it displays the wide range for development of each sound target.

Some children need more time to master sounds with any number of factors influencing that timeline. Ear infections, fluid buildup, wax, growth, attention issues can delay sound mastery for months or years in some children.

In 2018, McLeod and Crowe published a study updating developmental expectations for speech sound development. Note that these researchers suggest that all speech sounds are acquired by six years. Under these guidelines, more children may qualify for speech services.

McLeod-Crowe-2018-English-consonants-Treehouse-A4

After the Evaluation:

You just learned that your child is eligible for speech services due to an articulation delay. If you are in early intervention, then you likely will not see specific sound targets in your treatment plan, but that all changes in an IEP- Individualized Education Plan.

Let’s walk through the meetings that lead to an IEP in the school system. First, attend a brief referral meeting at the school to determine testing needs with the team. A couple months later, you will reconvene and review all test results. If your child qualifies for speech, then you will create an IEP at that eligibility meeting. Listen carefully to the goals for speech articulation, which are written to be met in one year. Given that these goals must be achieved in a year, they should be concise, measurable, and appropriate for your child’s age.

Here is an example of an achievable objective, focusing on an early sound production: Increase accuracy of /b/ in all positions (i.e., ball, cowboy, web) of words with 85% accuracy.

Here is an example of a lofty goal which should be divided into smaller components as there are 18 objectives in this one example: Increase accuracy of /p, m, h, n, w, b/ in all positions at the word level with 85% accuracy.

In summary, you have the right to ask questions during any meeting, be it for eligibility or treatment planning. If goals seem unattainable, express concerns during IEP meetings. Parents are one of the most important team members because you know your child best!

Therapy:

Your child needs articulation therapy when he substitutes or distorts one or more sounds. For example, he may substitute the /w/ for /r/ in the word rabbit or distort the /l/ in the word ladybug such that the /l/ does not sound clear and crisp. In articulation therapy, we teach lip and/or tongue placement for target sounds. Here, we progress from isolated sounds to sentences and practice sounds in all word positions: initial, medial, and final. So, someone working on the /s/ sound may practice “sun”, “glasses”, and “cats.” Typically, we look at mastery in one position before moving onto another. We target developmentally appropriate sounds and increase the level as the child progresses.

Homework:

Your speech pathologist will want your child to practice sound targets at home once progress is noted in treatment sessions. Waiting for accuracy is crucial; clients who practice at home generalize skills, reducing therapy time and ensuring error-free practice.

Conclusion

In summary, understanding speech sound development lays the foundation for effective evaluation and treatment of articulation disorders. By incorporating home programming into therapy plans, caregivers can play a crucial role in reinforcing progress outside of sessions. Consistent practice in natural environments enhances therapy outcomes and promotes long-term speech proficiency.

Childhood Apraxia of Speech CAS: Why it’s Treated Differently

by Nanette Cote

Childhood Apraxia of Speech (CAS) is distinctly different than articulation and phonological delays with regards to evaluation, diagnosis, and treatment. If you’re confused about your child’s speech delay, it’s best to consult an experienced speech pathologist in a timely manner. At the end of this post, I share some resources for finding that speech pathologist in your area.

The late Pam Marshalla, a renowned Speech Pathologist, said it best in the opening to her book, Apraxia Uncovered- Seven Stages of Phoneme Development, “Children with apraxia and dysarthria do not respond well to traditional speech therapy methods and procedures, rather they need a therapy that actually teaches them how to make their speech mechanism function correctly.” Explore causes, theories, and defining characteristics of apraxia and how it differentiates from speech delays.

What is Apraxia?

Apraxia of speech is a condition that impacts one’s ability to plan sequential movements for speech productions. According to a well-known researcher and diagnostician, Dr. Edythe A. Strand, “Apraxia is due to deficits in the planning and programming of movement gestures for speech production.” Like dysarthria, apraxia can be acquired or developmental. Probably the most frustrating thing about a developmental apraxia diagnosis for some families is that it’s cause is unknown.

In cases with unknown causes, experts theorize about issues like motor planning or breakdowns in language processing, but definitive answers are lacking. These theories suggest problems with language frameworks or sensory-motor integration affecting speech. Effective therapy targets individual needs.

Common Characteristics of Apraxia

In the video clip below, a young child with CAS uses vowel distortions and has difficulty producing multiple syllable words.

Below is a list of characteristics common to many clients with apraxia of speech. This information was adapted from an informative website, www.apraxia-kids.org:

Errors on vowel productions
Variety of errors for one sound target (For example, may produce “mat”, “sat” or “hat” for the word “cat”)
Awkward speech movements, sometimes with groping that makes speech look difficult
Productions that are difficult to understand or distorted
Increase in errors as length or complexity of words increases
They may correctly say a target sound once but struggle to repeat it
More success with producing a word in a conversation, but cannot imitate the same word when asked
Slower rates/speeds when talking because sequencing sounds/words is such a struggle
Awkward prosody with limited to no use of stress on words, making speech sound robotic
Significant difficulty with repetitions
Age appropriate receptive/comprehension ability. Your child knows what he or she wants to say, but can’t sequence the complicated stages necessary for speech

How does CAS Differ from Dysarthria?

Dysarthria is an impairment in muscle movements for speech caused by damage in the central or peripheral nervous system. In many cases, dysarthria has a clear medical diagnosis, affecting muscle tone. Speech might sound weak, strained, or slurred, making it hard to understand. Therapy sessions focus on individual needs and may include oral motor exercises.

The common thread between dysarthria and apraxia is that both significantly impact a child’s ability to tell his articulators (lips, tongue, palate) how to move and sequence sounds. This delay is markedly different than that of an articulation or phonological impairment and it all comes down to movement. Therefore, it is imperative that speech therapy for motor speech disorders follow some kind of protocol that teaches muscle movements for speech. Research and my own personal experience have taught me that delivering therapy early and frequently is the most effective form.

What is the Difference Between CAS and Phonological Disorders?

A phonological delay happens when your child leaves out, swaps, or changes sounds in words. It’s common in kids but usually gets better by preschool. These mistakes happen because a child’s mouth muscles aren’t fully developed yet.

There are eight, phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, and gliding. For more information and examples of each of these, you can read my article: What are Phonological Disorders and Processes?

The Child Apraxia Treatment- Once Upon a Time Foundation has parent friendly videos with examples of a child talking with a phonological disorder and some children who have dysarthria of speech. Be sure to look at the video titled: Childhood Apraxia of Speech: How CAS is Different from other Disorders.

Who can Diagnose Apraxia?

As speech pathologists we need to seek specialized training in diagnosing and treating apraxia, otherwise, we cannot ethically work with children with motor speech disorders. These trainings require that we learn how to effectively use evaluation tools and therapy programs. Not all speech pathologists treat motor speech disorders. Parents have the right to seek professionals with appropriate credentials for their child. Rather than administer an articulation assessment, clinicians record children during play tasks to analyze speech motor movements.

Dynamic Assessment

Speech therapists use dynamic assessment as a specialized approach to evaluate and understand childhood apraxia of speech (CAS), a motor speech disorder in children. It’s designed to provide insights into a child’s speech abilities by observing how they respond to various prompts and cues during assessment. Unlike traditional assessments that simply measure what a child can or cannot do, dynamic assessment actively engages the child in tasks that gradually increase in complexity.

Dynamic assessment can be likened to a problem-solving session. Imagine your child is presented with different speech tasks, starting with simple ones like producing single sounds or syllables, and progressing to more complex tasks like forming words or sentences. Throughout this process, the assessor observes how the child approaches each task, noting strengths, weaknesses, and any patterns of difficulty.

What makes dynamic assessment valuable is its interactive nature. It allows the assessor to provide support and feedback tailored to the child’s responses. For instance, if a child struggles with a task, the assessor might offer additional cues or modeling to help them succeed. By observing how the child responds to these supports, the assessor gains insights into the underlying nature of the speech difficulties.

The Dynamic Evaluation of Motor Speech Skill (DEMSS)

The Dynamic Evaluation of Motor Speech Skill (DEMSS) assessment for apraxia provides a comprehensive evaluation framework that considers various dimensions of speech motor planning and execution. What sets the DEMSS assessment apart is its emphasis on providing tailored support and feedback. If your child struggles with a task, the SLP will offer cues, prompts, or modeling to help them succeed. By observing how your child responds to these supports, the SLP gains valuable insights into the underlying nature of the speech difficulties.

We may need to collect additional information, such as vocabulary, language, and social interaction assessments, depending on the child’s needs. In addition to speech interventions, it is best practice to teach other effective means for communication, determine if there are comprehension needs, address social communicative concerns, and work at your child’s level.

Treatments

In severe to profound motor speech disorders, speech pathologists support functional, effective communication for a child by finding the appropriate augmentative communication (i.e., PECS, SGD) that assist in making a child’s needs known. Once identified, therapy involves teaching the child and caregivers effective communication with the new support system.

PROMPT and DTTC therapy are evidence-based options that may suitable for your child. A speech pathologist must have rigorous clinical training in these approaches and pass competency assessments before providing either. You can search for a speech pathologist who specializes in evaluating and treating children with motor speech disorders at the apraxia kids website and/or PROMPT Institute.

Navigating childhood apraxia of speech (CAS) requires a structured strategy, such as utilizing the Kaufman Speech to Language Protocol, to prioritize motor planning and language development. Using Kaufman materials for CAS involves a systematic approach that emphasizes motor planning, syllable shapes, and functional vocabulary.

Conclusions

In conclusion, understanding childhood apraxia of speech (CAS) is crucial for effective intervention. By recognizing its characteristics, diagnosing accurately, and exploring treatment options such as PROMPT, DTTC, Kaufman Programming, and others, we equip ourselves to provide the best support for children with CAS. Early identification and intervention are key, offering hope for improved communication and quality of life for these individuals. Let’s continue to raise awareness and advocate for resources that empower both professionals and families in addressing CAS effectively.

PROMPT- Useful for Childhood Apraxia of Speech (CAS)

by Nanette Cote

Nanette Cote Providing Tactile PROMPT to Toddler

What is PROMPT?

PROMPT is an acronym for:

Prompts for Restructuring Oral Muscular Phonetic Targets. This is a dynamic, hands-on program for children with apraxia of speech in which the trained clinician shapes the movement of a child’s jaw, tongue, and lips using our hands in support of sound production. Although the use of touch and movement is an integral component, PROMPT is more than just executing tactile support. It is a program that incorporates all aspects of a child’s processing, understanding, and interaction.

These areas of development, or domains, are known individually as: The Cognitive-Linguistic, (ability & language), Social-Emotional (socialization), and Physical-Sensory (muscle tone & senses) Domains. Together, these domains function in unison and influence each other to the extent that challenges in one area directly impact progress in another. This video for families on the PROMPT website visually explains the domains and PROMPT’s multifaceted treatment approach. Some children that may benefit from PROMPT include those diagnosed with motor speech disorders like apraxia and dysarthria, cerebral palsy, and autism. To determine if PROMPT is appropriate for your child, your clinician will begin with an observation and comprehensive evaluation.

Evaluation:

PROMPT is rooted in a Dynamic Systems Theory, meaning that clinicians must factor in cognitive, social, behavioral, sensory-motor, and physical influences on communication. Let us break these down into some specific questions that we as clinicians ask ourselves during a comprehensive assessment process:

Cognitive: What is the child’s ability to process sensory information and comprehend language? Does the child need visual schedules and/or other modifications and cues to learn new information? How should clinicians and parents’ scaffold, cue, and elicit language with the child?
Social: Do we need to work on establishing trust before diving into PROMPT? How does the child express his wants and needs (i.e., pointing, gestures, sounds?) How is the child’s non-verbal communication? What communicative intents does the child relay (i.e., greeting, requesting, commenting, responding to questions?) Is the child interested in engaging in communication and interactions with others?
Physical: What is the child’s skeletal system and muscle tone like? Do we need to provide additional supports in the environment to support skeletal and/or musculature issues? Does the child have difficulty with vision, hearing, tactile/touch?

System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH):

In addition to collecting information from a parent interview, a PROMPT evaluation also includes analyzing the movements necessary for speech. These yes/no questions are based on typical speech development. Next, the clinician transfers the results to a visual representation to rate the severity of the speech disorder. The System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH) provide us with practical information to develop a treatment plan.

Well-Built House

Marcus Neal, a PROMPT instructor, describes the Motor Speech Hierarchy as a well-built house with a strong foundation (jaw) necessary for sustaining the other structures (lips, tongue.) The jaw is the first articulator to develop, so we need to make sure that this foundation is ready to support sophisticated lip and tongue movements. Jaw stability and the ability to open our mouths in four graded levels (minimal to wide) helps us sequence movements for speech. In PROMPT, we incorporate vowels into a child’s practice because vowels shape jaw movements.

After completing a SAO, clinicians calculate percentages for each of these areas: tone, phonatory, mandibular (jaw), labial-facial (lips-face), lingual (tongue), sequenced movements, and prosody (inflections/intonation.) Next, we shade in the boxes for each of these areas on the MSH to help identify points of intervention. Given the fluid interaction between these Stages, we need to address three areas to work on immediately. While we cannot change a child’s tone, it is important to note limitations and consult with OTs and PTs for suggestions on improving posture.

After selecting three areas to prioritize, we develop goals and vocabulary lists to practice words/ phrases during functional activities. This list will include a variety of vowels, consonants, and blends with emphasis on core vocabulary. From the start, we blend words into phrases to work on prosody (intonation). So, we model and support with PROMPTs, “ma more!” or “go ma?” The reason for working on prosody early on is to help make speech movements fluid and vary communication intentions.

Service Delivery:

Typically, young children with apraxia of speech benefit from at least two, 30-minute sessions. Depending on the degree of severity, services may range anywhere from a few months to several years. Other contributing factors that can impact longevity of services are medical conditions, cognition, social/pragmatic skills, sensory/tactile defensiveness, and comprehension delays.

Typical PROMPT Therapy Session:

If a child with apraxia of speech has limited verbal skills, then sessions will initially focus on using vowel sounds. As vocalizations increase, then PROMPT support shifts to productions of consonant sounds/words/phrases/sentences.

A typical 30-40 minute PROMPT session for apraxia of speech would proceed as follows:

Greeting and set up (5-10 minutes)
Motor phoneme warm-up reviewing the targeted words embedded in the session’s activities with 3-5 PROMPT supported repetitions per target. (5-10 minutes)
Most sessions have 2-3 activities, each lasting 5-10 minutes. These activities incorporate pertinent aspects from the Domains reviewed above factoring in picture supports, timers, movement breaks, supported seating, and any other cues the child may need for success. Speech sound movements are worked on during play to help the child attach meaning and strengthen memory.
Review home practice plan (5-10 minutes)

Here are some examples of activities that I have used for children with varying cognitive abilities during my PROMPT sessions:

early childhood: Toy Vet Play Set with word targets to address needs in tongue control and jaw movements (go, goes, take, push, home, help)
preschool: Play-Doh Kitchen Oven with words to help work on lips-face control with movements that require rounding lips (no, two, dough, do, “mo” for more)
elementary school-aged: Pop the Pirate Game practicing words that support improving jaw control, lip contact (pop, Bob, up, “hep” for help)
middle school-aged: Knock, knock jokes to address improving prosody (intonation) and tongue control (Who’s there? cat, kitten, bike, show)

PROMPT Supports:

There are four levels of PROMPT (Parameter, Surface, Complex, Syllable) with clinicians using at least 2-3 of these in one session. Here is a breakdown on each level and the type of support it provides a child:

Parameter: provides the most support you can offer through stabilizing/ moving the jaw and lips. There are 13 sounds supported at this level some of which include: h, p, b, m, sh, and vowels in words like “cat”, “father”, and “eat”.

Syllable: only used for consonant-vowel (CV) productions such as “go”.

Complex: helps the child contract and/or tighten his tongue to produce consonants such as (r), blends (sh), and vowels.

Surface: these supports specifically help a child with placing articulators accurately, timing movements using rhythm and prosody, and transitioning from one sound movement to another to create words.

Demonstration of Surface and Complex tactile for /s/

PROMPT and Teletherapy:

In 2020, PROMPT training for speech pathologists shifted from in person to virtual because of global shelter-in-place restrictions. The PROMPT Institute also developed specific training for clinicians using PROMPT via teletherapy. Parameter PROMPT offers the most support for a child and can be easily administered by a caregiver following a trained speech pathologist demonstration. Some surface PROMPTs can also be used in teletherapy with the clinician showing this support on herself, a doll, or willing assistant.

My hope in writing this post was to provide a thorough explanation of the dynamic intervention of PROMPT. This program is unlike any other that I have been trained in over the last two decades in the field of speech pathology, as I have witnessed tremendous success when applying this methodology with clients who have motor speech disorders. Both caregiver carryover and early intervention are crucial to these achievements, so please continue advocating for your child and seeking resources like the PROMPT website to further your knowledge and education.

If you want to find a speech pathologist in your area trained in PROMPT, then you can visit this link and conduct a search.

What are Phonological Disorders and Processes?

by Nanette Cote

Mastering Teletherapy for Early Intervention: Portrait of cute girl participating in auditory bombardment with headphones on

school teacher showing a book to the children

In this comprehensive guide, we’ll explore phonological processes, discuss age-related expectations, and outline your role in supporting phonological goals at home. Whether early intervention or the school system has identified your child for services, this post provides valuable insights.

Evaluation, treatment planning, and homework for phonological disorders differ significantly from articulation and childhood apraxia of speech due to their distinct nature. Please note that this post does not take the place of a comprehensive and diagnostic evaluation for your child. There are many factors that we assess when developing an appropriate treatment plan. Talk with your pediatrician, child’s teacher, and/ or speech pathologist if you have questions and concerns specific to your child.

PHONOLOGICAL PROCESSES

There are eight, phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, and gliding. Below are definitions, examples, and age expectations for suppression of each of these processes.

Syllable reduction: eliminating a syllable in a word should cease by 4 years old. For example, “puter” for “computer”.
Syllable structure: inability to produce part of a syllable. There are four of these such shapes (CV, VC, CVC, CVCV) with “C” representing “consonants” and “V” meaning “vowels.” Some examples of these shapes are: (CV) “bee”; (VC) “up”; (CVC) “cat”; and (CVCV) “baby.” A child with a phonological disorder may have difficulty producing several of these combinations for an undetermined length of time.
Cluster reduction: occurs when a child omits part of a blend, most often /s/ blends /sk, sm, sn, sp, st/. You may hear him say “kin” or “sin” for the word “skin.” Children should be able to produce blends together between 4-5 years old.
Final consonant deletion: omitting the last sound in a CVC word (“ca” for “cat”) should suppress by 3 years old.
Stopping: producing a sound that should be stretched like /s/ with a /b, d, p/ (“bun”, “dun”, or “pun” instead of “sun”) should end between 3-5 years old.
Fronting: making sounds that are produced further back in the mouth more towards the front. For back sounds /k, g, ng/, the tongue lifts in the back while the tongue tip stays down in the front of the mouth. A child who fronts sounds lifts the tongue tip to touch his palate and substitutes /t, d/ for back sounds. You may hear “tan” for “can” or “tookie” for “cookie” if your child is fronting. This process ends at 3.5 years old.
Backing: the reverse of fronting. Here, your child continues producing sounds made with the tongue towards the front of the mouth, lifting the back of his tongue. So, you may hear “do” for “goo” or “gog” for “dog.” This process is often seen in children with severe phonological delays.
Gliding: substituting an /r/ with /w/ (“wun” for “run”) or /l/ sound with /w, y/ (“yeyo” for “yellow”.) This process may continue through 6 years old.

PHONOLOGICAL

Evaluation:

Speech pathologists observe and screen before evaluations, guiding test choices. Analysis and probes help develop treatment plans for phonological delays.

A phonological delay is when your child omits, substitutes, and/or distorts a process. This is something that all children demonstrate at various ages, but eventually suppress as they enter the preschool years. These errors occur at a young age because a child’s speech mechanism (lips, tongue, jaw) is not yet fully, physically developed to move swiftly and precisely. As children grow physically, their speech becomes more intelligible. Those with phonological disorders may need auditory training to improve accuracy.

A phonological delay means multiple sound errors. For instance, using /d/ for /th/ in “thumb” doesn’t signify a delay. This example would likely be an articulation delay. However, if he uses /d/ in addition to one of more of these sounds: /j, sh, ch, th/ (i.e., “padama” for “pajama”, “dells” for “shells”, “lund” for “lunch”, and/or “dum” for “thumb”), then he has not suppressed a phonological process of stopping and needs intervention, especially if he is five years old or older.

One of my most popular, phonological goals is: Reduce cluster reduction for /s/ blends (sk, sm, sn, sp, st) in initial positions of words with 80% accuracy given supports as needed.

Therapy:

In phonological therapy, we work towards helping the child learn to suppress the process. The speech pathologist prioritizes processes occurring over 40% in a speech sample. Unlike articulation issues, phonological delays vary contextually.

Cycles Approach:

Speech-language pathologists use the cycles approach, a systematic and evidence-based method, to address phonological disorders in children. This method organizes therapy sessions into cycles, targeting specific phonological patterns for a predetermined period before progressing to the next set of targets. This approach aims to facilitate generalization of speech sound improvements across a wide range of contexts. Through repetitive practice and reinforcement, children gradually internalize correct speech patterns and improve overall intelligibility. The cycles approach emphasizes a holistic approach to therapy, incorporating auditory, visual, and tactile cues to support learning and retention. By addressing underlying phonological processes rather than individual sounds, it provides a comprehensive framework for addressing speech sound disorders effectively.

Auditory Bombardment:

Auditory bombardment in phonological speech therapy involves exposing the child to a high frequency of correct target sounds in various contexts. This technique aims to increase the child’s exposure to the target sounds, leading to improved auditory discrimination and comprehension. By repeatedly hearing the correct sounds, the child’s auditory system becomes more attuned to the target phonemes, facilitating the internalization of correct speech patterns.

Auditory bombardment helps to create a strong auditory model for the child to imitate, aiding in the acquisition and production of target sounds. Additionally, this approach can enhance the child’s phonological awareness and contribute to overall speech sound improvement. Overall, auditory bombardment is a valuable tool in phonological therapy, providing intensive auditory input to support speech sound development and remediation.

Homework:

mother and son — Photo by cottonbro studio on Pexels.com

It is nearly impossible to skip homework practice and make progress in phonological therapy. Again, your child’s speech pathologist will want a certain level of mastery in the therapy room before assigning homework practice. Once targets are identified, clients with phonological delays can benefit from engaging in listening training at home. Ask for appropriate book suggestions. The sooner you start, the better.

Conclusion

In conclusion, grasping the nuances of phonological processes is vital for effective intervention strategies. With thorough evaluation and targeted treatment plans, accompanied by diligent home programming, children can overcome phonological challenges more effectively. Encouraging parental involvement in home practice reinforces therapy gains and fosters lasting progress in speech development.

Tongue Tie: Impacts on Speech, Dentition, Feeding, and More

by Nanette Cote

Young Child Sticking Tongue out with Noticeable Tongue Tie

multiethnic family spending time together at home

Unlock the mysteries of tongue tie with our comprehensive, helpful guide tailored specifically for caregivers of children facing this challenge. We will define this condition, review identification, discuss the impacts, outline laser surgeries, and provide more reading material about tongue tie.

Tongue Tie Defined

Tongue tie, formally known as, ankyloglossia, restricts the tongue’s range of movement, making it challenging to reach the top palate or sides of the mouth. This movement is not only important for producing speech sounds, but also for manipulating foods to the sides of the mouth for chewing and clearing mouth pockets of leftover foods. The tongue is connected to the bottom of the mouth by a band of tissues called lingual frenulum. Tongue tie occurs when this collection of tissues is unusually short, thick, or tight. Children are born with tongue ties with some needing laser surgery to release the restriction.

How is Tongue Tie Identified?

Most often, a tongue tie is first identified by lactation consultants when nursing mothers have difficulty feeding their infants. Otherwise, your child’s speech pathologist may refer you to specialists for suspected tongue tie. Some behaviors observed in a child with tongue tie include:

Inability to point tongue straight out of the mouth
Difficulty lifting the tongue up inside the mouth and reaching the palate
Reduced ability to move the tongue from side to side
Small indentation at the tongue tip that makes the tongue look like a heart when the person sticks his tongue out
Unable to stick the tongue out past the lower teeth
Trouble with moving the tongue up when licking ice cream or lollipops

Speaking from personal experience, I have referred five clients over the last eight years to a local periodontist for suspected tongue tie. Two of those clients needed a tongue tie release surgery and soon after demonstrated immediate, notable improvements in both speech sound productions and feeding.

What Else can a Tongue Tie Impact?

In addition to a tongue tie, some clients also have lip ties. Beyond having implications on speech production, tongue and lip ties can also impact the following:

tooth decay
pain while brushing teeth
dental issues such as teeth crowding
food and texture aversions
chewing and swallowing difficulties
TMJ
facial tension
chronic sinus/ congestion issues
ear infections
migraines

Why are Laser Surgeries a Better Option than Clipping Tongue Ties?

Laser procedures completely disintegrate the restricted lingual frenulum with no reattachment of the muscles observed with children undergoing this procedure. According to a local periodontist, Dr. Robert Pick, who pioneered the using a carbon dioxide Laser Frenectomy technique with his team at Northwestern in 1983,

“The laser is fabulous for tongue tie release because there is no bleeding during and/or after the procedure, no suturing needed, minimal to absent swelling and scarring, almost no chance for recurrence and a decreased to complete absence of pain post-surgically! In addition to use of the laser surgical time is dramatically reduced.”

Observations during Tongue Tie Release

Dr Pick has been using his innovative laser procedure with pediatrics for over 30 years at his office. I called the office as soon as I finished exploring his website. A month later, I found myself observing a tongue tie release in Dr. Pick’s office.

The frenectomy, lasting 30 minutes, ensured numbing, keeping the patient informed and calm. Dr. Pick’s jovial manner and skilled surgery left a lasting impact. Within seconds of the laser surgery, the patient exclaimed, “I can finally stick my tongue out of my mouth!” The muscle vanished before my eyes and the tongue found freedom. Five minutes later, the procedure was complete, and the patient was heading out the door to a lunch date with mom.

Recommendations and Resources

For tongue tie surgery, seek a specialized surgeon. Dr. Pick’s expertise ensures successful releases. According to Dr Pick, he has not had to perform a second release on any patient that he has seen over the last few decades; however, he does refer post-operative patients to their speech pathologists and/or myofunctional therapists to teach the tongue new placements at rest and during speech productions. Below are some links and resources that you may find helpful in identifying red flags and performing post-operative exercises.

List of Published Articles Concerning Tongue and Lip Tie

Tongue Tie Babies

FREE Love Idioms Game for Valentine’s Day

by Nanette Cote

Valentine's Day Reinforcement Boxes and Tokens

Add love and fun to your Valentine’s Day plans with my free updated resource for engaging students in meaningful lessons! Engage upper elementary students with this FREE love idiom game for Valentine’s Day, teaching 20 idioms through meaningful conversations and context clues. I also enhanced the graphics with adorable Valentine’s heart emotions.

Don’t worry about finding materials – a quick trip to the Dollar Tree for small gift boxes and heart decor should do the trick. Alternatively, you can use Hershey’s Kisses if supplies are scarce. As for gameplay, students collect heart tokens in their boxes as they answer questions correctly. But here’s the twist – instead of counting tokens to determine the winner, students rely on their senses to make the call. So, get ready to shake things up and spread some Valentine’s Day cheer in your classroom!

FREEBIE

Why wait? Go grab your FREE love idiom game for Valentine’s Day for upper elementary students that encourages conversations. Now, you can teach your students to use context clues in interpreting 20 idioms. This resource includes idioms and sayings related to “heart,” “love,” and “red,” ideal for Valentine’s Day lesson plans! I even updated the graphics with this sweet, Valentines heart emotions listed for FREE by Creating4 the Classroom Clipart.

Simple Game Play

The Dollar Tree usually has small, Valentine gift boxes and plastic heart table decor, but if the shelves are cleared, then you could use Hersey’s Kisses. To play the game, students collect a heart token in their box as they answer questions correctly. Instead of counting tokens, players used other senses, like weighing boxes or listening for noise when shaken, to determine winners.

With this updated love idiom game for Valentine’s Day, you have a fantastic resource to engage upper elementary students in meaningful conversations. Incorporating idioms related to “heart,” “love,” and “red,” it’s perfect for any Valentine’s Day lesson. The simple gameplay, utilizing Dollar Tree finds or Hershey’s Kisses, adds a tactile and sensory dimension to the activity. Whether students collect heart tokens or listen for the noisiest box, they’re in for a memorable, enjoyable learning experience!

Why Straw & Cup Drinking are Better Options than Sippy Cups

by Nanette Cote

Honey Bear with Supportive Accessories for Teaching Straw Drinking

Just Say No to the Sippy

Sippy cups, prolonged bottle drinking, and excessive pacifier use can hinder oral development. As a speech pathologist, I advise families to switch to straw and cup drinking. This post aims to discuss why opting for straw and cup drinking over sippy cups can significantly benefit your child’s oral development and overall health.

A sippy cup mimics bottle feeding, promoting an immature sucking pattern. By age one, children should transition to straw or open cup. A suckle pattern means that your child needs to stick his or her tongue out of the mouth to drink. There is little to no tongue retraction involved in this movement. Most of the time, the liquid will drip out of a sippy if you turn it upside down.

Extended use of a bottle or sippy cup may promote poor tongue posture. As a result, you will notice your child’s tongue rest outside of the mouth and you may observe articulation difficulty, especially with production of sounds made inside the mouth along the palate (t, d, k, g, n). As toddlers grow, we want to support transitioning them from a suckle pattern to a more mature movement. Toddlers, particularly those with speech delays, often protrude their tongues slightly while speaking or eating. This tongue position mirrors the placement for suckle drinking.

Nuby Cup

Now that you know the pitfalls of using a sippy cup, let me offer two other options that not only secure liquids in a cup but also promote good oral motor development: a Nuby cup and straws. First, the Nuby cup looks like a sippy, but has a flexible top that encourages sucking rather than suckling to drink. The flow of liquid cannot drip out as easy as the sippy cup; rather it requires some effort, or sucking on the child’s part. Similar to straw drinking, this sucking pattern pulls the tongue back into the mouth thereby supporting good oral motor development.

Straw Drinking Supports

A built-in straw cup is another great option but can be a little challenging for beginners, so it may be easier to start with a regular straw. If your child is not sure how to use a straw, then trap some liquid in one end and slowly release that liquid into your child’s mouth once he puts his lips around the straw. In the event that your one-year old or child with special needs needs more supports in learning how to drink from a straw, then I would highly recommend the Bear Bottle Collection from Ark Therapeutics.

Bear Bottle, lip blocker, and one-way valve:

This adorable, bear-shaped bottle is a great way to transition your child from bottle to straw drinking with several supports for quick success. We attach a lip blocker to the straw to prevent excessive insertion into the mouth and encourage tongue retraction. This durable tool stays put after washing. There are three types of blockers sold by Ark Therapeutic which allow for graduation as your child improves his ability to position musculature for drinking without tactile feedback. The one-way valve traps fluid in the straw, preventing it from dropping back when suction is released. This makes learning to drink from the straw less effortful and sets the child on a quick path for success.

The Benefits of Straw Drinking

Straw drinking promotes tongue retraction into the mouth while drinking. To draw liquid from the cup, the tongue must retract into the mouth, a crucial movement for speech sounds like (t, d, k, g, n). You can also mix things up a little by varying the intensity of the straw. Shorter straws with thin liquids suit beginners, while longer or twisty straws with thicker liquids demand more effort. The latter version challenges older children to improve oral motor awareness. Drinking thick beverages with a straw improves lip and tongue awareness, aiding sound placements. Speech therapy alongside this change shows success.

I’ve long advocated for the straw’s benefits, even using seasonal ones as speech practice prizes. A small change can impact development significantly. While eliminating sippy cup usage is a great start, it will not be the only change that you need to make. Please continue working with your speech pathologist and practicing sound targets at home to develop muscle memory for improved articulation development.

Seated Drinking

Children don’t need a cup in hand all the time. Overconsumption of liquids from sippy cups can hinder eating. Many children fill up on these liquids, making it difficult for them to eat because their bellies have an excess. Plus, it is far more challenging for children to drink while walking around, than it is when they are seated. Toddlers focus on moving around, making drinking from a cup challenging. They might spill or choke as they navigate and drink. Seated postures for drinking are just more optional all around. Let’s make sure children are seated safely before offering drinks, though they can still have water throughout the day.

In conclusion, by eliminating sippy cups and opting for better drinking choices, you’re not just improving oral motor development but overall health.

How Many Words Should my Toddler Say?

by Nanette Cote

Mother sitting outside holding a child in her lap with a basket of fruit on the table in front of them

Prerequisites

Communication is an amazing and complicated ability that literally explodes in the early years leading many to ask how many words a toddler should say. For some toddlers, this explosion happens early while others are “late talkers.” This range makes it tricky to predict the right time to seek out an evaluation.

Monitoring a child’s language development is a critical aspect of understanding their overall growth. As children grow, they reach various developmental milestones that signal their progress. Speech development is one important area where caregivers and professionals look for specific advancements. Two-word phrases, for example, are a significant hallmark that typically emerge when a child is between 18 to 24 months old. Recognizing the number of words a child should know or use at different stages can be a useful gauge of their language acquisition.

A child pointing at objects while saying simple two-word phrases. By 15 months, they can say around 10-50 words

By 15 months old, it is expected for a child to say eight to ten words. This early vocabulary will usually include names for parents, common objects, and possibly a few action words. By 16 months, the expected range can increase to around 15 words as the child starts to experiment with sounds and the meaning associated with them. A 17-month-old might be expected to say a similar number of words, but individual progress can vary. Moving forward, an 18-month-old child may have a vocabulary of 20 to 50 words. By the age of two, a child’s vocabulary typically explodes to around 200 words, a significant increase that underscores the rapid development in this stage.

Key Takeaways

Speech milestones act as indicators of a child’s language development.
Vocabulary size typically expands rapidly between 15 months to 2 years of age.
The emergence of two-word phrases marks an important progression in speech acquisition.

Developmental Milestones Overview

A young child is pointing to objects and using two-word phrases to communicate. They are actively engaging in speech development, reaching the milestone of using around 15 words by 15 months

Understanding developmental milestones helps you monitor your child’s growth and developmental progress, particularly in speech and communication.

Speech Development Fundamentals

Speech development is a critical aspect of your child’s overall development. By 15 months, a typical toddler might have a vocabulary of 8 to 10 words, although it’s not unusual for the number to vary among individual children. By 16 months, your child should use at least 15 words, increasing to nearly 20 words consistently by 17 months.

At 18 months, a child’s vocabulary undergoes significant expansion, and they can often learn new words rapidly, with some children reaching over 50 word. Simple phrases like “more milk” and “mommy go” may emerge alongside this single word vocabulary development.

By 24 months, a child should comprehend at least 300 words, with some capable of understanding and using more. Variability is normal, and these figures serve as a general guideline. Speech development relies on both genetics and environmental factors, like interaction with parents and caregivers.

Early Communication Milestones

Age	Expected Vocabulary
15 Months	8-10 words: mama, dada, familiar objects
16 Months	At least 15 words
17 Months	Minimum of 20 words
18 Months	Rapid word learning, >100 words likely
24 Months	50 recognizable words, phrases emerging

Your child’s early communication includes gestures, babbling, and responsiveness to auditory stimuli even before the first word is spoken. You should observe increased intentionality in communication at around 18 months, with notable improvements in the complexity and clarity of expressed ideas. Early interactions greatly influence these milestones; engaging with your child through reading, talking, and playing supports their learning process.

Speech Milestones By Age

Understanding speech milestones helps you monitor your child’s language development effectively. Here are some highlights from the American Speech-Hearing Association (ASHA), when it comes to speech expectations:

By one year old, a toddler should say 2-3 words (such as hi, dog, dada, mama, uh-oh) and make attempts to imitate sounds.
Between 13 to 18 months, a toddler should say names of common objects, some actions, and important people. You will likely also hear long strings of sounds, syllables, and real words that appear conversational.
By two years, most toddlers should say over 50 words, which in turn gives them a large enough selection to combine single words into phrases like: “more apple”, “no bed”, “mommy book.”
Somewhere between 2-3 years, a toddler should be able to say sounds: p, b, m, h, w, d, n and most vowels in words. At 3 years old, toddlers are typically combining three words into a phrase to talk about things.

More Resources

As a speech pathologist, I often send families this Google Document with alphabet labeling and ask caregivers to fill in a word count. This information aids in documentation of the Rossetti Infant-Toddler Language Scale when it is time for an initial assessment. The Rossetti measures communication from birth through three years. While there are a number of factors in measuring communication development, for purposes of this post, these are the number of words a toddler should say by range:

15-18 months: says 15 meaningful words
18-21 months: uses single words regularly and imitates phrases
21-24 months: uses 50 different words
24-27 months: *MLU 1.50-2.00
27-30 months: *MLU 2.00-2.50
33-36 months: *MLU 2.50-3.00

*MLU: Mean Length of Utterance

Constructing Two-Word Phrases

A child pointing and naming objects, using two-word phrases, reaching developmental milestones in speech by 15 months

When you observe speech development in toddlers, constructing two-word phrases is a significant milestone. Around the age of 24 months, you will likely notice your child beginning to pair words together. This step is crucial as it represents the start of combinatorial speech, allowing your child to express more complex thoughts and needs.

Key Aspects:

Expression: Two-word phrases enable your child to convey relationships between concepts, like possession (e.g., “my toy”) or actions (e.g., “go home”).
Understanding: This stage reflects an increasing understanding of grammar and syntax, even in its most basic form.

Expected Progression:

Age	Milestone
18 months	Imitates two- and three-word phrases
20 months	Uses two-word phrases occasionally
24 months	Routinely constructs two-word phrases

Vocabulary Growth: Your child’s word bank typically includes 50-100 words by the time they are 2 years old. This richness in vocabulary supports the construction of meaningful two-word combinations.

Examples of Two-Word Phrases:

Requests: “More milk,” “Hold you,” “Help please”
Comments: “Doggie big,” “Truck loud,” “Shoe off”
Identification: “Mommy coat,” “Daddy car,” “Baby sleep”

You can encourage your child to form two-word phrases by reading to them, speaking in simple sentences, and naming objects during your daily routines. It is important to acknowledge and reinforce their attempts at speech. Each child develops at their own pace, but if you have concerns about your child’s speech development, consulting with a pediatrician or a speech-language pathologist might be beneficial.

Frequently Asked Questions

A child pointing at objects, babbling, and using two-word phrases while reaching for a bookshelf

This section addresses common inquiries regarding the progression of early language development in children.

By what age do babies typically start using two-word phrases?

You can expect babies to typically begin forming two-word phrases between 18 and 24 months. This is a natural progression as their vocabulary expands.

How many words should an 18-month-old typically be able to say?

At 18 months, a child may typically say between 20 and 50 words. The range is wide as individual growth varies.

What are the expected language milestones for an 18-month-old child?

An 18-month-old child usually recognizes names of familiar people, objects, body parts, and actions. They also begin to follow simple instructions, imitate two- and three-word phrases, and spontaneously say a two-word phrase on occasion.

At 2 years old, about how many words should a child know?

By the age of 2, children often comprehend about 300 words, express 50 recognizable, and combine words into short phrases.